Organization Active NPI

Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1154558740
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BAPTIST PRIMARY CARE INC
Practice address
11236 Baptist Health Dr Ste 220
Jacksonville, FL 32218-2988
Phone
(904) 696-6900
Fax
(904) 765-7149
NPI assigned
Jun 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marsha Donaldson
Title
Senior Vice President
Phone
(904) 376-3703

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

11236 Baptist Health Dr Ste 220
Jacksonville, FL 32218-2988

Mailing address

PO Box 45443
Salt Lake City, UT 84145-0443
Phone (904) 202-1032

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000248 FL Part B Supplier - Clinic/Group Practice 0648177733 Receives reassigned benefits from 567 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0860448Baptist Primary Care11236 Baptist Health Dr Ste 220, Jacksonville, FL 32218Provider-performed microscopyDec 21, 2027

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1154558740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45443",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841450443",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11236 BAPTIST HEALTH DR STE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322182988",
            "telephone_number": "904-696-6900",
            "fax_number": "904-765-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST PRIMARY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "904-376-3703"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.